5986 Management of spasticity in children with cerebral palsy in special schools and community complex needs clinics across cambridgeshire; holistic review!

Objectives To review our practice in the management of spasticity in children with cerebral palsy and to compare the results against the NICE guidelines for 'spasticity in under 19's': management' Methods A retrospective audit was carried out on the management of 50 children presenting with spasticity at different special schools and community clinics in Cambridgeshire over 2 years (2022 & 2023). Four clinical aspects of Cerebral Palsy (CP) care were assessed by studying the notes of all children. We gathered data regarding: Medication history Surgical history MDT involvement Consequences/Comorbidities. Results 64% of patients were GMFCS 3 or more. Almost 80% required orthoses. 47 out of 50 children received regular physiotherapy and Botulinum toxin was injected in 31 patients. All of them had follow up post-injections. (figure 1). 15 patients were on Baclofen to treat spasticity; however only 6 patients were on Diazepam. 4 patients had Spinal Dorsal Rhizotomy within the last 5 years with good outcomes. Hip surgery was the most common orthopaedic intervention, which was done in 22 patients, followed by tendon release in 21 patients. Hip X-ray was done in timely manner in 45 out of 50 patients (according to Cerebral Palsy Integrated Pathway 'CPIP' protocol) and the delayed ones were due to hospitalisation or being unwell. Almost half of the patients developed either pain or contractures (as a result of their spasticity) with 30% of patients requiring change of their individualised functional goals. Epilepsy, constipation and visual problems were the most common associated comorbidities. Seizure medications, laxatives and dystonia medications were noted to be used in large proportion of patients. Multivitamins and Vitamin D intake were documented in only 12 patients. (Figure 1). Conclusion Our practice met the recommendations of the NICE guidelines for 'spasticity in the under 19's'. This standard of care could be used as a beacon of excellence to demonstrate the gold-standard of care for CP children with spasticity. We have created MDT template for following up children with complex physical needs with solid recommendation to advise and document regular use of multivitamins/Vitamin D to support bone health. We advised to monitor the response to treatment, complications, comorbidities and to further check the frequency of hip surgeries in these children and if it has been reduced over the last few years while following the CPIP Guidance. We suggest future studies to demonstrate any possible reduction in the number of hip surgeries required as a result of implementing the CPIP guidance. References Overview | Spasticity in under 19s: management | Guidance | NICE. Cerebral Palsy Integrated Pathway – an interprofessional approach | NICE.